Provider Demographics
NPI:1740842426
Name:VAUGHN, HUNTER (NP)
Entity type:Individual
Prefix:
First Name:HUNTER
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 LAKE CREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:MS
Mailing Address - Zip Code:39110
Mailing Address - Country:US
Mailing Address - Phone:601-668-3825
Mailing Address - Fax:601-612-0509
Practice Address - Street 1:203 CALHOUN STATION PARKWAY
Practice Address - Street 2:BUILDING 200, SUITE H
Practice Address - City:MADISON
Practice Address - State:MS
Practice Address - Zip Code:39110
Practice Address - Country:US
Practice Address - Phone:601-668-3825
Practice Address - Fax:601-612-0509
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903401363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily